Preparing for surgery

Fitter Better Sooner

Advice from the Royal College of Anaesthetists

Endorsed by:
Preparing for surgery | Fitter Better Sooner

Your role in preparing for surgery

Having surgery is a big moment in your life and it’s normal to feel anxious about it.
Fitter patients who are able to improve their health and activity levels recover from surgery more
quickly. What you do now can have a really big impact on your recovery.
Taking an active role in planning and preparing for your operation will help you feel in control,
leave hospital sooner and get back to normal more quickly. Waiting times for surgery may be
longer in some areas, but you can use this time to prepare for your surgery.
This leaflet will give you general advice on what you can do to get the best outcome from
your surgery.

A patient story by Roger (not his real name)

I was overweight and a lifelong smoker. The surgeon and anaesthetist had already told me that
my surgery would be more difficult and that I would need to stay in the High Dependency Unit
(HDU) afterwards, which might delay the date of my surgery if a bed wasn’t available.
My anaesthetist spoke to me about some changes that I could start to make to help my recovery
and encouraged me to read the information in Fitter Better Sooner and watch the animation (at
youtube.com/watch?v=2CUMpUwX0x4). That evening I watched the animation with my family.
My daughter knew how worried I really was. They encouraged me to have a go at making some
lifestyle changes.
I had wanted to stop smoking for a long time but never had the will to go through with it. It was
hard, but eventually I managed. I also decided to start walking and tried to walk slightly further
each day. Before I only walked somewhere if I really had to, but I really started to enjoy it. I felt
myself get fitter and also got to know the people living in my area.
I have diabetes but I’d not taken it very seriously. I made an appointment at the GP surgery. The
nurse helped me understand more about what food I should eat to better control my diabetes
and encouraged me to gradually lose some weight. She gave me a machine to help me keep
an eye on the sugar level in my blood. I lost 4kg in the six weeks before my surgery. Feeling
healthier and fitter gave me a lot more confidence going for my surgery. I had been quite
depressed and worried about it before.
After my op I was on the HDU for a day and then back to the ward. I was in hospital longer
than I should have been, because my wound did not heal well at first, but I had no serious
complications. The physio at the hospital gave me breathing exercises and encouraged me to
walk around the ward to keep active and speed up my recovery.
Three months after my op I am still feeling the benefits of the changes I have made. I don’t need
my inhaler as often as I used to and I find it easier to walk up the stairs. I still love my walks, my
weight keeps dropping and I feel much more optimistic about the future.

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Preparing for surgery | Fitter Better Sooner

The healthcare team

Many staff from different healthcare professions will work together to make your surgery and
recovery go smoothly. They will look after you before, during and after your surgery. This is often
referred to as the perioperative team. But it all starts with you.
You will meet many people along your surgical journey. Below are some members of the
perioperative team:

Nurses Physiotherapists

YOU
Anaesthetists Specialist
doctors

Surgeons and Pharmacists

ward doctors

Practice nurse GP

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Preparing for surgery | Fitter Better Sooner

Preparing your body

Lifestyle changes
There are many changes you can make to reduce the risks of surgery.
Small changes, even over a short time, can make a big difference.

Exercise
Your heart and lungs have to work harder after an operation to help the body to heal. If you are
already active, they will be used to this. While you are waiting for your operation, try and increase
your activity levels.
Brisk walking, swimming, cycling, gardening or playing with your children or grandchildren are
all helpful. Swimming can be helpful for those with obesity or joint pain. Try to do any activity
which makes you feel out of breath at least three times per week. Start slowly and stay within your
limits. Take advice if exercise is difficult for you. Stop and ask for medical advice if you develop
new problems including chest pain, dizziness or your heart beat becomes irregular. Activities that
improve your strength and balance will also be useful for your recovery, for example daily ‘sit-to-
stand’ exercises.
You can see some examples here: https://bit.ly/39gX5jF

Who can help me?

■ There are a number of mobile apps to help you set goals and track your progress, such as
‘Active 10’ and ‘Couch to 5K’. More information at: https://bit.ly/3u8WZlN
■ Try joining a free council or community walking group or environmental volunteering scheme
in your local area. As well as giving you encouragement and support to start walking and
exercising, they are enjoyable and will boost your mood. Ask your GP surgery what is available
in your area.
■ If you have back or joint pain and you see a physiotherapist, ask them for exercises that you
can do. There is also information on exercising with arthritis here: https://bit.ly/3bBUi65
■ For people who are frail, a gentle walk every day, sit-to-stand exercises, stairclimbing and
reducing time sitting are a good start.
■ Depending on where you live you may have access to NHS ‘health trainers’ who can help
motivate you and offer advice.
These are only some ideas and there will be many health and fitness programmes that you can
explore in your local area.
Preparing for surgery | Fitter Better Sooner

Healthy diet
Your body needs to repair itself after surgery – eating a healthy diet
before and after your surgery can really help. This means getting
enough protein and ‘5 a day’ or more of fruit and vegetables. These
help wound healing and your immune system.

Who can help me?

The following website has useful resources and information:
■ NHS – Eat well: http://bit.ly/2N1xoDi
Your GP surgery may be able to give you some advice and information
on healthy eating if they have a dietitian service.

Weight
If you are overweight, losing weight can help reduce the stress on your heart and lungs. You can
find out if you’re a healthy weight using the NHS BMI healthy weight calculator:
https://bit.ly/3bBTZIt
Losing weight can also help you to:
■ lower your blood pressure
■ improve your blood sugar level
■ reduce pain in your joints
■ reduce your risk of blood clots after surgery
■ reduce your risk of wound infections after surgery
■ allow you to exercise more easily
■ reduce the risks associated with having an anaesthetic.
More information about the benefits of losing weight before an operation and the increased risks
of having surgery with obesity can be found here: https://bit.ly/RCoAYourWeight

Who can help me?

There will be local weight loss schemes and exercise opportunities in your
area. The NHS has a Weight Loss Plan app. Your GP surgery or pharmacy
may be able to weigh you and signpost you to advice on healthy eating. If
you have obesity, your GP may also refer you for bariatric (weight loss)
surgery to reduce the risks and improve your outcomes before they
refer you for other procedures. Some councils also have schemes that
can support you so it is also worth looking at your local council website
or contacting them.
You may find it helpful to join a weight loss class. In some areas, NHS
health trainers may be available to help you.
More information and additional resources can be found at Better Health –
Lose weight: https://bit.ly/3xSsO3i

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Preparing for surgery | Fitter Better Sooner

Alcohol
Alcohol can have many effects on the body, but importantly it can reduce the
liver’s ability to produce the building blocks necessary for healing. If you drink
regularly you should make sure you are drinking within the recommended limits
or lower. If you drink more than this, you should also aim to cut down before
your operation to improve your body’s ability to heal after surgery and to avoid
withdrawal symptoms during your stay in hospital.

Who can help me?

You can find information on recommended limits and how to reduce the amount of alcohol you
drink on the following websites:
■ NHS tips on cutting down: https://bit.ly/3A9NJBK
■ NHS Better Health – Drink less: https://bit.ly/3yk7T9V

Smoking
Stopping smoking is hard, but the good news is that quitting or cutting
down shortly before surgery can reduce your length of stay in hospital and
improve wound healing and lung function. Preparing for surgery offers a
real opportunity to commit to stopping smoking.

Who can help me?

Find out if there is a local Stop Smoking Service in your area.
You can check here: https://bit.ly/3QVBnDt
The following organisations have useful information on the benefits of
quitting smoking before surgery:
■ The Cure Project – a helping hand to stop smoking: this gives useful
information about the added benefits of stopping smoking early before
surgery (https://bit.ly/3L9Tph3)
■ Action on Smoking and Health (ASH):
● Stopping Smoking Guide (http://bit.ly/2N7FLgG)

● Briefing: smoking and surgery (https://bit.ly/3FEmQGN).

Medical conditions
Many medical conditions can affect recovery from surgery. It is important to make sure any
known conditions are controlled as well as possible ahead of your surgery.
You can also book in for a general NHS health check at your GP surgery if you are between 40
and 74 years old.

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Preparing for surgery | Fitter Better Sooner

Diabetes
Good control of your blood sugar is really important to reduce your risk of
infections after surgery. If your blood sugar readings or HbA1c measurement (a
blood test that checks your longer term diabetic control) is high, you may benefit
from changes to your medication or diet.
Think also about your diet and weight. Your diabetic control will improve if you lose
weight. For patients with type 2 diabetes, with or without obesity, a Mediterranean or a low
carbohydrate diet can be helpful. More information on diabetes and diet can be found here:
https://bit.ly/3u8pDn3
If you haven’t had your HbA1c checked in the past six months, you can request a test at your GP
surgery. If needed, the team can recommend any changes well ahead of the operation. This will
reduce the risk of your surgery being delayed.

High blood pressure (hypertension)

Blood pressure should be controlled to safe levels to reduce your risk of heart
disease and stroke. Sometimes operations may be delayed if it is too high. If you
haven’t had your blood pressure checked in the last year, or you know your blood
pressure is poorly controlled, ask for a check at your surgery well ahead of your
operation. Some pharmacies also offer blood pressure checks.
If you have, or borrow, a blood pressure machine you can let your GP surgery know the result.
Some GP surgeries have automated machines and you may not need to make an appointment
to use these.
If your blood pressure is high, your GP can check your medications and make any changes
needed ahead of the operation.
Lifestyle changes can help control and reduce high blood pressure. You can find more
information here: https://bit.ly/3ymfkhP

Anaemia (low levels of iron in the blood)

Treating your anaemia before surgery reduces the chance of you needing a
blood transfusion. It will also help your recovery and make you feel less tired after
your surgery.
One third of adults having major surgery are anaemic. If you have been bleeding or if you have a
long-term condition, request a blood test at your GPs to check whether you are anaemic.
Anaemia should be diagnosed as early as possible for the treatment to be effective. If you are
concerned that you might be anaemic, you should talk to your GP, pharmacist or surgical team
about treatment to improve your blood count well ahead of the surgery.
Many people have iron deficiency anaemia and a diet consisting of iron rich foods, such as green
leafy vegetables, meat and nuts, can help. Some people also need more vitamin B12 and folate:
■ iron is found in: red meat, beans and nuts
■ vitamin B12 is found in: meat, fish, cheese or eggs
■ folate is found in: green leafy vegetables, broccoli, brussel sprouts, asparagus, peas, chickpeas,
brown rice and liver.

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Preparing for surgery | Fitter Better Sooner

If picked up early, anaemia is usually treated with iron tablets and an iron rich diet. In some cases
you may be offered a dose of intravenous iron given through an infusion directly into your veins.
This works more quickly than tablets, but there are some additional risks. An infusion is usually
offered if the surgery cannot be delayed.
You can find more information here: https://bit.ly/3OMo0DD

Heart, lung and other medical problems

If you have any other long-term medical problems, consider asking your GP surgery
for a review of your medications, especially if you think your health is not as good as
it could be.

Anxiety and mental health

Most people feel some anxiety about having surgery. If the thought of going into
hospital is making you very anxious or upset, it may be helpful to talk about your
concerns with your GP. In some areas, GPs can refer you for specific support.
You find out more information about how to manage anxiety before an operation
here: rcoa.ac.uk/preparing-your-mind-surgery
Many techniques including mindfulness, relaxation, breathing exercises or yoga can help you
relax before and after your surgery.
If you are taking medication for your mental health, it is important to let the team at the hospital
know about this during your preoperative assessment. They will usually ask you to continue this
medication throughout your hospital stay. It is important to take it to the hospital with you. They can
also help organise any specific support you might need for your time in hospital or return home.
You can find more information and support at NHS Better Health – every mind matters:
https://bit.ly/3ymSS8n

Dental health
If you have loose teeth or crowns, a visit to the dentist may reduce the risk of
damage to your teeth during an operation.
It’s also important to have good dental hygiene and for your teeth and gums to be
in good condition before the surgery, as this will reduce the risk of infection.
More information can be found here: https://bit.ly/3QPMTjA

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Preparing for surgery | Fitter Better Sooner

Practical preparation for your operation

We know that coming into hospital for surgery can be a worrying time. Talk to your family and
friends about going into hospital and tell them how they can help you. Don’t underestimate how
tired you may be afterwards.
Give the below checklist some thought well in advance of the operation.
e How will I pass the time? – have some headphones and music, books, tablet computer or
puzzles. Don’t forget chargers.

e What can I do to relax? – learn some breathing and mindfulness techniques, try yoga or listen
to relaxing music and calming apps. In addition, the RCoA, in partnership with the British Society
of Clinical and Academic Hypnosis (BSCAH), has produced a series of recordings which might
help you to relax before surgery (rcoa.ac.uk/patientinfo/preparing-your-mind-surgery).
e What do I need to prepare at home? – you may find it difficult to move around when you return
from hospital – you might consider sleeping on the ground floor and getting mobility aids if you
think you’ll need them, but generally you will recover quicker if you keep moving after surgery.
e Who can look after my elderly relatives? – if friends and family cannot help, contact your
local council and your local carer service (https://carers.org).
e How will I get to and from the hospital? – can someone drive you? If you are eligible for
hospital transport, the hospital may be able to organise transport for you.
e Do I have enough easy-to-cook meals and healthy snacks for when I get home? – think
who might be able to help prepare meals or help with your shopping afterwards. You might want
to sign up for a home delivery service with a supermarket or store some meals in your freezer
before you go to hospital.
e Who can look after my children or pets? – ask friends and family to help or to be on standby.
To help you with childcare, they may need to arrange time off work too. If you have significant
difficulties looking after your children following an operation, talk to your local council or your
health visitor.

e Do I have enough medication and batteries for my hearing aid to last me in hospital and
when I get home? – you will usually be asked to take your usual medication into hospital with
you in the original packaging. Remember to take this and all your personal belongings back
home with you when you are discharged.

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e Do I have some over-the-counter painkillers at home? – you may need to

take some during your recovery as instructed by the hospital.
e What do I need to pack? – if you are staying in hospital
overnight you should think about toiletries, nightwear, comfortable clothes
and footwear which is sturdy but easy to put on. It is important to get out
of bed, get dressed and start to move as soon as your operation allows –
those who do this get home sooner and recover quicker. Temperatures in
hospital can vary, so some layers of clothing can be useful. See NHS
Choices for further information: http://bit.ly/2KV68Ks
e What else would be helpful to do? – get your house and garden in order.
Get up to date with your general affairs and finances. This will mean you do
not have to worry about these whilst you recover.
e Whom should I let know I am going into hospital? – friends and family can
usually give you practical support. It is also good to have people to talk with whilst you are at
home recovering. Many people will want to help your recovery, so let them know how they
can help in plenty of time.
e Should I have a shower/bath before going to hospital? – this is important to minimise the
risk of infection. You may also be given antiseptic wash to use to help further reduce the risk.

e What happens if my surgery is delayed? – the preoperative assessment team will contact
you if your procedure needs to be postponed and they will advise you on restarting any
medication that might have been stopped.

Practical questions to ask your perioperative

team about your surgery
Members of the perioperative team at the hospital will discuss your anaesthetic, surgery and
recovery period. They will talk through any particular risks you might have from both your
anaesthetic and surgery and any choices you have. They will give you information to read at
home. There will be a contact number to ring if you need to ask more questions.
The better prepared you are, the easier the process is likely to be.

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Below are some questions that you might want to ask the perioperative team.
■ What time do I need to stop eating and
drinking before surgery?
■ Are any changes needed to my medication
before and on the day of my surgery?
■ What do I need to pack for the hospital?
■ Do I need to remove nail varnish, gels
or piercings?
■ Can I have visitors? When are the
visiting times?
■ Will someone at the hospital shave me if
needed before my surgery?
■ When can I Drink, Eat and Mobilise (get
up and walk around) after my operation
(DrEaMing)? I have heard this can help get
me home sooner?
■ When can I expect to go home?
■ What help can I expect to need at home
afterwards?
■ How long will it be before I can shower/
bathe again?
■ Are there any important ‘dos’ and ‘don’ts’ for
my recovery?
■ Will I have stitches or staples that need to be
taken out?
■ How much time will I need to arrange
off work?
■ Who will give me a fit/sick note for my
employer?
■ Will I have a check-up afterwards?
■ How long might it be before I can walk/
swim/play golf/run again?
■ When can I drive afterwards?
■ How long will it be before my life is roughly
back to normal?
You can also read our FAQs about anaesthesia:
rcoa.ac.uk/patientinfo/faqs

What time
do I need to stop
eating and drinking
before surgery?

What can I expect during my recovery?

Your recovery starts immediately after your operation when you are still in the hospital. For many
surgical procedures there is now no need to rest in bed for a long time after surgery or the need
to be ‘nil by mouth’ postoperatively. Many hospitals will aim to get you Drinking, Eating and
Mobilising within 24 hours of surgery, known as DrEaMing. Patients who do so have shorter
hospital stays and reduced complications. Ask the healthcare team when you can drink, eat or
mobilise after the operation.

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Preparing for surgery | Fitter Better Sooner

Before you leave the hospital, your nurse will give you written information about what to expect
during your recovery at home and how to manage any pain you might experience. This will also
include anything to look out for and a number to call if you are worried.
Our factsheets (rcoa.ac.uk/fitterbettersooner#toolkit) on some of the most common surgical
operations give more detailed information on how to prepare for different types of surgery and
what to expect afterwards.

Practical help to keep you motivated

during your recovery Do es
Geted exer
dress
cis

Depending on what surgery you are having, recovery may

take many weeks. Don’t worry if some days go better than
others, as this is normal. It can be useful to keep a recovery
diary which you can continue after you go home. Try and
get into a routine and get up in the morning at a regular
time. A list of daily goals can give structure to your day and
help monitor your progress.
Visits and phone calls from family and friends can cheer
you up and encourage you to reach your goals. If you have
the technology, make use of WhatsApp, Facetime and
online platforms like Zoom to keep in touch with people.
Be careful though not to tire yourself out.

Additional resources available online

Royal College of Anaesthetists
■ Preparing for surgery: Fitter Better Sooner animation and procedure specific leaflets
(rcoa.ac.uk/fitterbettersooner).
■ Caring for someone who has had a general anaesthetic or sedation
(rcoa.ac.uk/patientinfo/sedation).
■ Risks associated with your anaesthetic (rcoa.ac.uk/patientinfo/risks).
■ Patient information series (rcoa.ac.uk/patientinfo/leaflets-video-resources).
■ Information for children, carers and parents (rcoa.ac.uk/childrensinfo).

Centre for Perioperative Care

■ Resources on shared decision making (https://bit.ly/3AaQFOL).
■ Guidance for adult patients having an operation during COVID-19 (https://bit.ly/3NrmcPe).

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NHS Getting Better Sooner

■ My role and my responsibilities in helping to improve my recovery (https://bit.ly/3a2kdDh).

British Dietetic Association

■ Information on diet and nutrition (https://bit.ly/3u8hTSa).

Royal College of Surgeons of England

■ Recovering from surgery (http://bit.ly/2NdA1SH).

What does the term ‘enhanced recovery’ mean?

Enhanced recovery is the name given to a programme that aims to get you back to your normal
health as quickly as possible after a major operation. Hospital staff look at all the evidence
of what you and they can do before, during and after your surgery to help give you the best
chances for a quick and full recovery. This should get you home sooner.
The programmes will vary depending on what operation you are having and which hospital you
are being treated at, but may include:
■ improving your fitness levels before your operation if there is enough time
■ treating any other long-term medical conditions
■ reducing the time you fast by giving you water and carbohydrate drinks
before your surgery
■ giving you medication to prevent sickness after surgery
■ considering the best ways of giving pain relief during the operation
■ using local anaesthetic blocks or regional anaesthetics where possible
■ giving you the best pain relief afterwards to get you moving quicker
■ encourage you to Drink, Eat and Mobilise within 24 hours of surgery
(DrEaMing)
■ reducing the time you have catheters and drips
■ teaching you exercises to help you recover after your operation.
By following an enhanced recovery programme, there are usually fewer complications after
surgery. There is also less chance of you needing to go back into hospital again.

Disclaimer
We try very hard to keep the information in this leaflet accurate and up-to-date, but we
cannot guarantee this. We don’t expect this general information to cover all the questions
you might have or to deal with everything that might be important to you. You should
discuss your choices and any worries you have with your medical team, using this leaflet as
a guide. This leaflet on its own should not be treated as advice. It cannot be used for any
commercial or business purpose.
For full details, please see our website: rcoa.ac.uk/patientinfo/resources#disclaimer

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very difficult for patients to read. Please also make sure that you use the latest version of this
leaflet, which is available on the RCoA website: rcoa.ac.uk/fitterbettersooner
A full list of authors and contributors to this leaflet can be found at:
rcoa.ac.uk/patientinfo/authors-contributors

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Second Edition, May 2022

This leaflet will be reviewed within three years of the date of publication.

© 2022 Royal College of Anaesthetists

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